House Minority Leader Nancy Pelosi last Thursday rejected the notion that Democrat Alex Sink’s narrow loss to Republican David Jolly in last week’s special election in Florida — in a congressional district that Republicans have held for half a century — was a referendum on Obamacare.

“I’m very proud of our House Democrats, not only how they’ve embraced the Affordable Care Act … but how proud they are of it,” Pelosi said. “I think the Republicans are wasting their time using that as their election issue and they will find that out.”

Pelosi went on to say, however, that, “there are some things (about the law) that need to be fixed.”

She didn’t suggest what those things are, but I’m betting at the very least she wishes she and others who helped write the law had made it simpler for people to get the insurance protection they need.

The reform law made many of the insurance industry’s most despised practices illegal, like refusing to offer coverage to applicants with pre-existing conditions and canceling people’s policies when they get sick.

And the ACA now requires insurers to provide information about their policies in understandable language and in a format that enables people to compare one plan with another. It also established federal and state health insurance “exchanges” to make shopping for coverage more convenient and less stressful.

But despite those and other important benefits of the law, trying to figure out which health plan among many is best for you is anything but a walk in the park.

With only two weeks left before the March 31 deadline to enroll in a plan for 2014, I talked to Rachel DeGolia — one of the specially trained ACA navigators who is helping folks in Cleveland, Ohio, figure out how to move out of the ranks of the uninsured — to find out how she would fix the law if she had the power to do so.

I also consulted the 114-page “Navigator Resource Guide” developed by the Center on Health Insurance Reforms at Georgetown University Health Policy Institute to help navigators like DeGolia deal with all the questions they get every day from folks.

Although DeGolia still believes a single-payer system would be better than the multi-payer system the ACA is built upon, she nevertheless considers the law “a huge step in the right direction.”

But, she says, lawmakers need to figure out how to make coverage more affordable and to reduce the complexity that has defined the health insurance industry for decades.

“Coverage is not as affordable as many people need it to be yet,” she says.

In the 25 states that have expanded their Medicaid programs to include residents with incomes up to 138 percent of the federal poverty level, the people at the lower end of the income spectrum are in many cases better served by the law than middle income individuals and families.

“If you make $30,000 and can find an affordable premium but still have a $5,000 deductible, that’s not a great deal if you get sick,” she said.

“It doesn’t make sense to me why we have to have these high deductibles,” she added. “Maybe they exist because people need to have ‘skin in the game,’ but I haven’t met people who overuse services. That’s not the norm. I’m afraid the deductibles will be so high for some people that it will deter them from getting the care they need, even if they are insured.”

And because plans with the highest deductibles have the lowest premiums, she says she worries that people will “settle” for a plan that provides less comprehensive coverage than then they really need.

Another problem with the health plans being offered on the exchanges is that many of them have “narrow” provider networks, meaning that a person’s doctor might not be included.

“It’s a challenge is to help people who have never had insurance to explain it to them,” said DeGolia. “You can easily spend two hours with them. It’s a big learning curve.”

DeGolia also wishes the ACA didn’t limit enrollment to just a few months a year — which brings me to that Georgetown Navigator Resource Guide. Here’s Question 37 (of 270):

“Why can’t I buy a plan when I need it? Why do I have to wait for the open enrollment period?

Answer: If everyone were allowed to wait until they were sick to buy coverage, premiums would be very expensive . . . Health insurers need a mix of healthy and sick people to make premiums fair for everyone.”

Of course, if everyone were covered and automatically enrolled in a single-payer system as in other countries, there wouldn’t be a need for open enrollment. Our health care system is complex in large part because we have so many payers.

(3) Comments

posted by: ocoandasoc | March 17, 2014 4:00pm

“Coverage is not as affordable as many people need it to be yet.”
That’s a fairly inane statement… NOTHING is as affordable as a lot of people need it to be.
And “high deductibles” actually make healthcare insurance MORE affordable, not less.
The costs also vary from State-to-State. Here in TN my wife’s coverage (with no government supplement) costs $325 per month (64 year old female). In our previous home State (CT) an identical policy would have been twice that.
I lobbied hard for the ACA and, like thousands of others, received a nice plaque from the President for my efforts. It is a good deal better than what we had before. But there are flaws in the program and my prediction regarding young people not signing up has certainly come true. (The assumptions projected were political wishful thinking aimed at getting the bill passed.) My hope is that, like Medicare, the government can work on it over the next couple of decades and get it right.
My other prediction, BTW, is that the ACA will encourage a much higher percentage of 62, 63, 64, and 65 year olds to take early retirement which will put a strain on Social Security but simultaneously create a lot of job openings. For many – even those in high-salaried positions – the costs of healthcare insurance for themselves and their spouses in the years leading up to Medicare eligibility are the biggest impediment from exiting their jobs. The added benefit of lower ACA healthcare insurance costs in areas already favored by retirees will also speed their exodus from States in the Northeast and North Central regions where retirement costs are prohibitive.

posted by: timelord | March 17, 2014 4:04pm

“I think the Republicans are wasting their time using that as their election issue and they will find that out,” said Pelosi.

You may be right, Congresswoman, but my own prediction is that it’s YOU will be proven wrong. Now we only have to wait few months to learn who was the better prognosticator!

posted by: timelord | March 17, 2014 4:12pm

Rachel DeGolia brilliantly commented that, “Coverage is not as affordable as many people need it to be yet.”

There are lots of things in life that are not as affordable as many people need. Gasoline, heating oil, electricity, food, clothing…

Why? Take a good hard look at taxes and government regulations and you’ll see. “But,” you say, “we need government regulations to keep us safe!”

Maybe we do and maybe we don’t; that’s a debate for later. There are thousands of regulations that directly favor one company or small group of companies over others in virtually every industry. Those regulations serve no purpose other than to reduce competition and, as a result, raise prices to the consumer.